Abstract : Background:
Most studies about septic shock report a crude mortality rate that neither distinguishes between early
and late deaths nor addresses the direct causes of death. We herein aimed to determine the modalities of death in
septic shock.
Methods:
This was a 6-year (2008
–
2013) monocenter retrospective study. All consecutive patients diagnosed for septic
shock within the first 48 h of intensive care unit (ICU) admission were included. Early and late deaths were
defined as occurring within or after 3 days following ICU admission, respectively. The main cause of death in the
ICU was determined from medical files. A multinomial logistic regression analysis using the status alive as the
reference category was performed to identify the prog
nostic factors associated with early and late deaths.
Results:
Five hundred forty-three patients were included, with a mean age of 66 ± 15 years and a high proportion
(67 %) of comorbidities. The in-ICU and in-hospital mortality rates were 37.2 and 45 %, respectively. Deaths occurred
early for 78 (32 %) and later on for 166 (68 %) patients in the ICU (
n
= 124) or in the hospital (
n
= 42). Early deaths were
mainly attributable to intractable multiple organ failur
e related to the primary infection (82 %) and to mesenteric
ischemia (6.4 %). In-ICU late deaths were directly related
to end-of-life decisions in 29 % of patients and otherwise
mostly related to ICU-acquired complications, includi
ng nosocomial infections (20.4 %) and mesenteric ischemia
(16.6 %). Independent determinants of early death were age, malignancy, diabetes mellitus, no pathogen identification,
and initial severity. Among 3-day survivors, independent risk factors for late death were age, cirrhosis, no pathogen
identification, and previous corticosteroid treatment.
Conclusions:
Our study provides a comprehensive assessment of septic shock-related deaths. Identification of risk
factors of early and late deaths may determine differential prognostic patterns.